California Insurance Lawyer Blog

Social Security Death Master File - What Do MetLife, Prudential, and other insurance companies do with it?

Fri, 18 May 2012 10:01:48 -0800

The Social Security Death Master File is an ominous name for a benign computer database maintained by the Social Security Administration (SSA). The Death Master File is simply a list of the names of people whose deaths have been reported to the SSA. What is less benign, however, is what insurance companies like MetLife and Prudential have been doing with the Death Master File.

These insurers regularly check the list to look for names of beneficiaries and when they find them, they stop paying for the annuities that were funding the life insurance benefits being paid. What these companies do not do is check the list for names of policyholders in order to notify beneficiaries that they may make a claim. The problem is that very often, unless the policyholder has informed a beneficiary that he has been listed as a beneficiary in the policyholder’s life insurance policy, that beneficiary would have no way of knowing that he was named, or that he could make a claim upon the policyholder’s death. In other words, insurance companies are acting with only their bottom line – and not their policyholders’ best interests - in mind.

While there have been lawsuits filed against MetLife and Prudential for this conduct, and a settlement has been reached, there really is no protection for consumers to prevent this practice from happening in the future.

In order to best protect yourself and your beneficiary(ies) with regard to the life insurance benefits for which you or your employer have been paying premiums is to ensure that you do the following:

(1) Inform your beneficiary(ies) that you have named him/her(them) in your life insurance policy as the beneficiary(ies).
(2) Keep a copy of your life insurance policy and the instructions for making a claim in a safe place.
(3) Tell your beneficiary(ies) where your policy is kept and make sure they will have unrestricted access to it.

Believe it or not, insurance companies often find reasons to deny life insurance claims! If you or anyone you know is ever in that position, we can help.

Raising Awareness About the Importance of Disability Insurance

Thu, 17 May 2012 10:05:26 -0800

In honor of Lupus Awareness Month and MS Awareness Day on May 30, 2012, we want to raise awareness about an issue most people don’t often think about until they get sick and can’t work: disability insurance. A recent Chicago Sun-Times article pointed out that between the ages of 25 and 65, people are four times more likely to become disabled than to die. Many people who become disabled by disease may be unable to work because of symptoms from the disease or side-effects from the treatment. In that case, disability insurance will pay the bills. Financial reporter Terry Savage suggests that employees invest in individual disability coverage over and above what employers may provide. See, “Disability Insurance More Crucial Than You May Think.”

When many think of disability, the image of someone in a wheelchair comes to mind. The irony of that is, with accommodation, many people in wheelchairs are able to work long and productive lives. This may not be so for some people with Lupus or Multiple Sclerosis, as well as Fibromyalgia, Chronic Fatigue, Crohn’s Disease, Parkinson’s disease, HIV/AIDS and even cancer. These diseases are often called invisible disabilities because the sufferer may not look disabled even when he or she is unable to work. And many of those have a hard job convincing their disability insurer they need the benefits they paid for.

Savage stresses there are other reasons why disability insurance isn’t perfect. It will never pay your full salary, and if you are in an extremely high income bracket, it may cap out at $10,000 a month. Still, Savage says, nothing else compares to “paycheck insurance” if you become too ill to work.

We agree, and few things are more rewarding to us than helping people recover their disability benefits after they have been denied. If that has happened to you, call us at (800) 446-7529. We can help.

Frustrated by the Long Term Care Insurance Claim Process?

Wed, 16 May 2012 09:51:58 -0800

It is no secret that the claims process of a long term care claim is frequently frustrating and confusing. Many of the insurers who originally sold the policies are no longer in business or have discontinued writing new business. In our opinion, this affects the claim process.

Clients frequently come to us with the same complaints: The carriers have lost their claim submission on multiple occasions, they repetitively request more information on a piecemeal basis, and/or the claim denial does not give an adequate explanation of the reasons for the claim denial. The following are some tips for submitting a claim which will also assist you and your attorneys if you ultimately file suit over a claim denial:

1. All communications should be in writing and keep a copy of all documents you receive or send to the insurer. If you do speak to a claim representative on the phone, obtain their name. Keep a journal of all oral communications so that you can accurately re-create what has occurred in connection with the claim.

2. Carefully review all claim paperwork before it is submitted. A LTD claim requires a physician to specify a “plan of care.” Usually, there is an area on the attending physician statement form where the “plan of care” is to be specified. The plan of care should detail what type of care is required and for what period of time, i.e., “home health aide, 7 days a week, 12 hours a day.”
3. If you are seeking benefits for care rendered in a facility, i.e., a nursing home or an assisted living facility, check the facility’s license before you submit the claim. Many older policies will not pay benefits for an assisted living facility. In addition, if the policy requires that a nurse “supervise” the facility, ensure that the facility you have chosen meets those requirements.

4. If you are told that the Policy has lapsed for non payment of premiums, consult with an attorney immediately. Most policies have protections against an unintended lapse. However, there may be a time limit on obtaining a reinstatement.

We have helped many, many clients recover the long term care benefits to which they are entitled. In our experience, meritorious claims have been denied as a result of careless claims handling. We are experienced in identifying where the claim adjuster mis-handled the claim and can assist you or your loved one in recovering benefits.

National Fibromyalgia Awareness Day 2012: Exposing the Painful Stigma of Fibromyalgia

Fri, 11 May 2012 15:25:47 -0800

The National Fibromyalgia & Chronic Pain Association (NFMCPA) announces May 12 as Fibromyalgia Awareness Day.

This year’s theme is “Make Fibromyalgia Visible.” This theme was chosen because of the often subjective nature of this difficult to diagnose, and widely misunderstood, disease. Over 10 million Americans suffer from this chronically painful and debilitating condition, however the stigma of this disease’s legitimacy still lingers.

This disease is typically characterized by a constant, dull, and widespread ache, multiple tender points, abnormal pain processing, sleep disturbances, fatigue, headaches, insomnia, depression, and anxiety. Fibromyalgia cannot tangibly be diagnosed through labs or x-rays, leaving doctors and patients with an often lengthy and grueling process of elimination.
National Fibromyalgia awareness day serves to promote an understanding of the illness. Through the efforts to put Fibromyalgia and Chronic Pain in the public consciousness, the campaign hopes to promote the allocation of recourses for research and education, to provide support and resources for families, and, ideally, to facilitate the removal of the stigma which creates a barrier against treatment and further understanding of the disease.

For more information on the events surrounding National Fibromyalgia Day: Click here.

Kantor & Kantor has successfully represented many clients with Fibromyalgia who have been denied health or disability benefits from their insurance companies. There is often an infuriating obstacle that lies between those with Fibromyalgia and obtaining the benefits needed to continue living a financially secure and relatively healthy life: an unfortunate stigma that this disease does not actually exist. Many insurers and employers do not perceive Fibromyalgia to be a legitimate physical illness. Consequently, many insurance policies treat it as a condition with limited health or disability benefits. Kantor & Kantor understands that the symptoms associated with Fibromyalgia can make it extremely difficult to get out of bed, to work, or to receive adequate treatment. We also understand that these symptoms typically do not change over time, necessitating long term disability or health benefits.

According to the Mayo Clinic, “Fibromyalgia generally doesn't lead to other conditions or diseases. But the pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.” The roots of this are disease are mystifying and ambiguous. Nevertheless, what we can easily gather from the millions of people that suffer with identical symptoms is that its chronicity and incapacitating nature is relentless. See http://www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=complications

An important piece of advice that we have learned from working with our clients is the significance of finding a physician that understands the disease and supports your treatment plan. Additionally, it is much more valuable for you to see a rheumatologist (a musculoskeletal specialist) versus a general internist. Rheumatologists are often far more familiar with Fibromyalgia and can help you get the proper information and treatment.

If you or someone you know has been denied health, short term, or long term disability benefits for fibromyalgia, contact Kantor & Kantor at (800)446-7529 or www.kantorlaw.net. We can help.

Top 10 Things To Consider and Look For in Your ERISA Health Plan

Mon, 16 Apr 2012 17:11:24 -0800

1. Obtain a full copy of your Plan. The full Plan will not be a benefit summary or a print-out from a website. It will be, on average, at least 50 pages long. The claims administrator will likely not have a copy of the full plan. You can request a copy of the full Plan from your Human Resources department.

2. Read the Plan. A customer service representative for a health insurance company or claims administrator may tell you what your benefits are over the telephone. You cannot rely on what a representative tells you over the phone. The Plan document controls the benefits available, not what someone tells you over the telephone. Ask the representative to tell you what specific Plan provision they are referencing and ask them to send you a letter documenting what they are telling you.

3. Look outside the Plan. Although the Plan should include all terms of coverage, often the claims administrator will apply their own criteria or guidelines to claims decisions. You can find many criteria or guidelines for claims administrators such as UBH, Cigna, and Aetna on the internet.

4. Is the Plan insured or self-funded? Insurance law applies to insured plans, not plans that are funded by the employer. So, for example, mental health parity laws do not apply to self-funded plans. Large employers such as AOL and Wells Fargo, fund their own plans.

5. Time to appeal a claims decision. Read the appeals or grievance section to determine your appeal rights and deadlines. The first appeal must be submitted within 180 days pursuant to ERISA. However, a second level appeal can be a much shorter time period, as little as 30 or 60 days!

6. Read the definitions. Definitions for certain levels of care, such as skilled nursing or inpatient hospitalization, will inform you as to how the Plan will classify your treatment.

7. Statute of limitations. This will be the period of time by which you must file a lawsuit to obtain disputed benefits. To file a lawsuit for benefits pursuant to an ERISA plan, you must first submit appeals (at least one, but no more than two). The statute of limitations may appear in a section titled “Legal Action.”

8. Who is the Plan Administrator? Look for a name and address of the Plan Administrator in the Plan. If your claim has been denied, send a written request to the Plan Administrator for all plan documents. The Plan Administrator is required to provide the plan documents to you within 30 days. 29 U.S.C. § 1024. Federal regulations allow you to file a lawsuit to seek penalties from the Plan Administrator in the amount of $110 per day for each day the plan documents are not provided. 20 U.S.C. section 1132(c)(3); 29 C. F. R. § 2575.502c–1.

9. Calculate your deductibles, co-pays, co-insurance. Yearly deductibles, co-pays, and co-insurance are confusing and can be applied incorrectly. Brush up on your math to do the calculations yourself to ensure that your claims are paid in full.

10. Find out who has “discretion” to decide your claim. Discretion is a key word in the world of ERISA. It means that the entity with “discretion” has permission to decide everything about your claim. An example of discretion in a Plan may be: “Anthem Blue Cross has discretionary authority to determine benefit eligibility and construe the terms of the Plan.” If the entity who has “discretion” is also the entity that pays the claim, then the entity has a conflict of interest.

If you have any questions, call us for a free consultation. (800) 446-7529

Amyvid - Drug to Diagnose Alzheimer’s Highlights Dilemma That Disease Still Has No Cure

Fri, 13 Apr 2012 16:11:29 -0800

Pharmaceutical manufacturer Eli Lily has developed a new drug with the ability to help doctors diagnose Alzheimer’s disease rather than rely on symptoms alone to determine if a patient is suffering from the debilitating brain disease. Up to now, the only way to definitively conclude Alzheimer’s, which has symptoms very similar to dementia associated with aging, has been to autopsy the brain after the sufferer’s death. The drug, Amyvid, identifies the presence of “amyloid plaques” caused by Alzheimer’s in the living brain. This may be good news for the 5.4 million Americans living with the disease and their families who want a conclusive diagnosis. See, “A New Way to Detect Alzheimer’s,”

On the other hand, the drug may cause more problems than it solves. According to Dr. Clifford Saper, Chairman of Neurology and Harvard’s Beth Israel Deaconess Medical Center, most people older than 80 have some level of amyloid in their brains, and the amount of amyloid present doesn’t necessarily indicate whether the patient has the disease or not. “There is no change in the care of most patients based upon knowing this information, as we have no specific treatment for Alzheimer’s disease,” Saper told ABC News.

The largest ripple Amyvid is causing is the potential for controversy about who is going to pay the significant cost for the diagnostic test, the government or insurance companies. Medicare and Medicaid already spend $130 million annually to treat Alzheimer’s.

The good news for people with long-term care (LTC) insurance who suffer from either Alzheimer’s or dementia is that – at least for now – LTC insurers for the most part don’t differentiate between the two. Most people quality for their LTC benefits when they need help with at least three activities of daily living, such as eating, bathing or dressing. Most policies allow for care at home, in a traditional nursing home or in an assisted living facility, options that should be preserved no matter what disease you may acquire as you age. Sadly, though, we are receiving more and more calls from families with a loved one fighting for benefits to pay for Alzheimer’s care.

If you are in that situation, you likely need experienced legal counsel to force your LTC insurer to pay the benefits you deserve. Call us at (800) 446-7529. We can help.

Aetna Refuses to Pay Long Term Disability Benefits to Client with Multiple Sclerosis.

Wed, 11 Apr 2012 10:07:46 -0800

Recently we filed an opening trial brief for a client who is disabled by Multiple Sclerosis (“MS”) related symptoms. The matter is set for trial against Aetna Life Insurance Company (“Aetna”), in the United States District Court, Northern District of California, before the Hon. Claudia Wilken.

Our client was diagnosed with relapsing-remitting MS in 1992. After going back to school to acquire new job skills in an effort to elongate his ability to work with MS, our client worked as a Customer Service Center manager for Office Depot in a Bay Area warehouse. By doing so, he was able to continue to financially support his wife and two children.

MS is a disease in which the body’s immune system eats away at the protective sheath that covers the nerves in the brain and spinal cord. This damage interferes with the communication between the brain and spinal cord and the rest of the body. If the nerves themselves deteriorate, the process is not reversible.

Relapsing-remitting MS is characterized by unpredictable relapses of acute worsening followed by periods of relative quiet where no new signs of disease activity occur. The nerve damage done by the relapsing MS attacks may resolve or it may become permanent. In this manner, the disease results in a gradually progressive deterioration of neurologic function. Because the disease attacks the brain and spinal cord, it is easy to understand why some of the main symptoms of MS include cognitive impairment, tremors/spasms, and urinary incontinence.

In 2006, a series of MS attacks began on our client’s nervous system. These attacks reduced our client’s ability to work. Taking every step possible to continue working, our client returned to work in 2007, because Office Depot was able to provide him with job accommodations. Unfortunately, in 2008 the MS attacks on our client’s brain returned. Since then, our client has been totally disabled due to symptoms of fatigue (MS lassitude), cognitive impairment, urinary incontinence, ataxia, dizziness, and tremors. The disabling nature of these symptoms is so common, a fact which Aetna acknowledges on its own website: “Multiple sclerosis, sometimes called just MS, is a disabling neurological illness.”

Because our client is no longer able to work, he made a claim to Aetna for disability benefits under his company’s Short Term Disability (“STD”) Plan, and later, its Long Term Disability (“LTD”) Plan. Aetna has never recognized our client as being disabled. At all times Aetna has claimed our client is able to perform his own occupation. This was wrong.

To prove that Aetna’s actions were illegal, Kantor & Kantor presented the Court with evidence that Office Depot’s actions in the real world supported our client’s disability. We produced evidence that Office Depot had terminated our client’s employment because he was no longer able to work his own occupation.

We also argued to the Court that Aetna’s own medical reviewers had agreed that our client was disabled. Kantor & Kantor comprehensively laid out evidence that eight different doctors (four of them hired by Aetna) had come to the conclusion that our client was no longer physically able to work his light duty occupation. (The U.S. Department of Labor assigns all occupations in the national economy a one of five physical demand levels – sedentary, light, medium, heavy, and very heavy. These levels reflect job duties such as the amount of lifting, pushing, walking, standing, and sitting required to perform the job.) We pointed out that two of these doctors were totally unaffiliated with our client or Aetna. Those two doctors had been hired by the Social Security Administration, and they had found that our client was disabled from any occupation in the national economy.

After Kantor & Kantor sued Aetna, we engaged in a discovery battle to obtain even more evidence that Aetna’s denial of disability was wrong. After Kantor & Kantor filed a Motion to Compel in Federal Court, Aetna produced its own claims handling guidelines. Even though Aetna claimed this information was confidential and privileged, we were able to show the Court that Aetna’s own guidelines appear to dictate an award of disability benefits for our client. We have forced Aetna to explain why it deviated from its own guidelines to deny our client’s disability claim.

Because the disability insurance in this case is part of an employee benefit plan, the matter is governed by the law of ERISA. ERISA limits the remedies available for an insurance company’s wrongful conduct to a recovery of benefits, and an award of attorney’s fees and costs at the Court’s discretion. We hope for our client’s sake, and for all of those who suffer a similar fate at the hands of their disability carrier, that the Court will remedy the injustice perpetrated by Aetna in this case.

Long Term Care (LTC) Policyholders Are Devising Custom Care Arrangements, But Will LTC Insurers Join the Trend

Sat, 24 Mar 2012 09:22:14 -0800

Some aging retirees are creating custom living arrangements providing the full range of services typically available at assisted living facilities but also combining travel and adventure at the same time, reports the Wall Street Journal. See, “The New Retirement Resorts,” http://online.wsj.com/article/SB10001424052702303717304577277341462803340.html.

Such arrangements include full-time spas, serial cruises, co-housing, bungalows in caregivers’ backyards, and even fully staffed houses in foreign countries – all for less than what they would pay for the same level of care at traditional facilities. Much of the impetus for these novel care options comes from adult children reluctant to confine their still-active and alert parents to one-room domiciles. Instead, they are researching and planning alternatives that provide flexibility, daily care, family interaction and fun.

Of course, this begs the question: How will long-term care insurance providers respond to claims that include these creative care arrangements?

According to Rona Loshak, a New York long-term care insurance broker, as long as the policyholder needs help with at least two activities of daily living – dressing, bathing, feeding, etc. – LTC policies should cover the expense, particularly, she told the WSJ, if the policy has “alternative plans of care” language.

We’ll believe that when we see it. In the meantime, if you are having difficulties getting your LTC insurer to cover your long-term care expenses – whether in a traditional facility, at home, or for a custom care arrangement, give us a call at (800) 446-7529. We can help.

Finding Ways to Pay for Increasing Long-Term Care Premiums

Thu, 22 Mar 2012 18:11:48 -0800

We are always quick to advise friends and clients that even though you may have to fight for long-term care insurance benefits when you need them, it is still wiser to invest in a good policy rather than rely on Medicare to cover all your long-term care expenses. Because it won’t. So what should you do now that several of the LTC carriers have stopped selling insurance, and worse, the 2012 National Long-Term Care Insurance Price Index shows LTC premiums have jumped from 6 % to 17 % since 2011? Fox News and Insurance.com offer a few considerations that may help you save on LTC Insurance. See, “Tips for Buying Long-Term Care Insurance Amid Rising Rates,” http://www.foxbusiness.com/personal-finance/2012/03/16/tips-for-buying-long-term-care-insurance-amid-rising-rates/.

First, you should comparison shop. The cost for similar policy may vary as must as 132%, says the American Association for Long-Term Care Insurance. Always ask experts, though, to make sure you are purchasing the insurance from a reliable company. Second, buy young when you are healthy. Costs increase as you age. Third, talk to your tax adviser about federal tax deductions that allow you to deduct LTC premiums as medical expenses. Fourth, consider buying a hybrid life insurance policy that also functions as a LTC policy if you need help for long-term care expenses.

If you are considering cancelling a LTC policy because of rising premiums, you may want to contact your insurer to negotiate a better rate or different coverage. That policy may be your only safety net if you become sick or disable after you retire. And then, if you have to fight for your long term care benefits, call Glenn Kantor, Esq., or Corinne Chandler, Esq. or Alan Kassan, Esq. at Kantor & Kantor (800) 446-7529. We can help.

LINA (Cigna) Life Insurance Denial: The Discretionary Clause Strikes Again

Mon, 30 Jan 2012 10:39:07 -0800

A recent Wall Street Journal article tells the story of our client Celina Whinery, who is suing Life Insurance Company of North America (LINA), a unit of Cigna, after the insurer refused to pay benefits the policy promised upon her husband’s death because he died in a one-car accident while legally intoxicated.

LINA argues that an insured who is legally intoxicated at the time of death is not entitled to benefits -- even though the policy does not exclude intoxication. Even though the policy language does not support LINA's argument, the insurer is forcing beneficiaries around the country to sue for benefits, and then appealing the cases it loses, which is most of them.

LINA knows how to exclude drunk driving from a claim for accidental death. It has a policy form that does exactly that. Those policies are less expensive however, since benefits are further limited. Instead, LINA sold a policy to CitiGroup (Mr. Whinery’s employer) in which it charged CitiGroup more money for a policy that did not exclude drunk driving. When Ms. Whinery made a claim on the policy (asking LINA to make good on their promise to pay), LINA denied the claim saying death due to drunk driving is not an accident and thus not covered. So, LINA makes more money by charging CitiGroup for the more expensive policy, but administers and denies claims as though they are dealing with the less expensive policies that expressly contain the exclusion.

LINA told Ms. Whinery that the policy defined accident. It didn’t. Moreover, the definition of accident LINA says was in the policy is not the definition of accident that the Appellate Court ruled applies in this type of case.

To make matters worse, LINA has an internal “authoritative” claims manual instructing that in cases of drunk driving, if there is no “intoxication exclusion” that claim must be paid.

So why is LINA forcing Ms. Whinery to sue for benefits? Mainly because federal law gives carriers of employer-based insurance the “discretion” to decide which claims they will – or will not – pay, as long as the decision is not "arbitrary or capricious."

Thankfully, California, enacted a law this year that now bans the enforcement of so-called "discretionary clauses" in insurance contracts (Insurance Code section 10110.6). Going forward, insurers will have to persuade the courts that their denials are supported by credible evidence. The law might not help Ms. Whinery, who told the Wall Street Journal, “Emotionally, you are going through a lot of things, and then to add this [unfair denial] on top, it makes it even worse.”

CBS News Comments on Policyholder's Fight with Bankers Life for Long Term Care (LTC) Benefits

Tue, 10 Jan 2012 09:36:56 -0800

A recent CBS News segment relates the story of Timber Harwood, a 93-year-old long-term care insurance policyholder fighting Bankers Life for benefits after he was seriously injured in a fall and needed the care of an in-home health aide. See “Some long-term healthcare policies not paying up,” http://www.cbsnews.com/8301-500202_162-57352805/some-long-term-healthcare-policies-not-paying-up/.

For more than a year, Bankers Life repeatedly “lost” or “misplaced” hundreds of pages of Harwood’s documents supporting his need for benefits while he used his life savings to pay for care. Things improved when Harwood’s niece – Kansas’s top insurance regulator – stepped in to help. Bankers Life eventually paid his claims, but then concluded he is “too healthy” to need in-home care, so the benefits stopped. Harwood and family are so worn down by the process they have decided not to pursue benefits.

The report concludes that LTC insurance isn’t paying as advertised and that customers should expect hefty premium increases.

We have also witnessed Bankers Life (and other LTC carriers’) claims handling practices, and have sued them to force them to pay. In our opinion, the worst thing a family can do is to give up the fight and let the carriers get away with not paying the benefits they owe.

Many people are successfully fighting their LTC carriers for benefits. Some of them have had to hire contingency fee lawyers like us to do it, but they made the decision that it’s more sensible to attempt hold their insurer accountable then spend their life savings on care they paid an insurance company to provide for.

Every LTC carrier is going to make you prove you need benefits, and some won’t make the task easy. Others will make the process discouraging and next to impossible. When that happens, find someone who understands how to deal with LTC insurers to help you. Most people aren’t as lucky as Mr. Harwood was to have an insurance regulator in the family to come to the rescue. Still, family members can help by calling and writing letters to the insurance company and demanding that they act expediently. Complain to the insurance commissioner of your state if the company does not respond to your inquires, or is acting irresponsibly. Usually, squeaky wheels get the grease. If all else fails, find an attorney with experience in this area.

We sincerely hope Mr. Harwood is indeed too healthy to need LTC benefits, but if he isn’t he shouldn’t give up the fight. And no one should. If Bankers Life or any other insurance carrier has denied your benefits, fight for your rights and make them pay what they owe!

Glenn Kantor and Corinne Chandler to Present National Business Institute Teleconference on Long Term Care Legal Issues

Fri, 30 Dec 2011 13:21:12 -0800

Kantor & Kantor partners Glenn Kantor and Corinne Chandler will present a National Business Institute teleconference “Troubleshooting Long Term Care Insurance Claims,” Thursday, January 26, 2012, at 10:00 a.m. Pacific time. The presentation, designed for a national audience of lawyers seeking to expand their knowledge about claims-handling practices and litigation strategies, provides up to two hours of continuing education credit. Topics the program covers include an overview of the state of the long-term care insurance industry, how to analyze common long-term claims and benefits denials, and creative litigation tactics.

For more information, or to register, follow this link: http://www.nbi-sems.com/SemTeleDetails.aspx/R-58789ER%7C?ctname=SPKEM.

The National Business Institute is one of the nation’s largest providers of legal and professional education, serving over two million professionals.

Kantor & Kantor is one of the largest law firms in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters. For more information, call (800) 446-7529.

Insurers Incorrectly Rely Upon ‘Magic Johnson Effect’ in Case Regarding AIDS Disability Benefits

Mon, 28 Nov 2011 13:54:53 -0800

We are about to bring a case to trial for a client who is disabled by AIDS-related symptoms, and has been since 1994. For more than 15 years, our client had proven his inability to work in any occupation, and Fort Dearborn Life Insurance Company paid benefits according to his disability policy. Without any warning, however, Fort Dearborn terminated our client’s long term disability benefits -- even though the medical evidence regarding his symptoms and the Social Security Administration’s disability determination remained unchanged.

What Fort Dearborn claimed had changed, according to its surveillance of our client, was his ability to perform limited activities of day-to-day living. Notably, for over a decade, our client had informed Fort Dearborn that he was capable of exactly that level of limited activity. So why the termination?

In its argument to the Court, and without a scintilla of evidence to support the claim, Fort Dearborn wrote:

“[Plaintiff] completely ignores the fact that there have been advances in medicine and numerous examples of HIV patients who have gone on to lead meaningful and industrious lives.”
…
“The former National Basketball Association player, Ervin [sic] 'Magic’ Johnson is one such example.”

Essentially, if Magic is fine, the argument goes, our client is fine.

Twenty years ago Earvin “Magic” Johnson made an announcement that altered the public’s perception of himself and HIV/AIDS. Clearly Magic’s courage in publicly confronting this disease had a significant positive impact on the public’s awareness of the actual facts regarding HIV/AIDS.

In 1991, it was widely believed that Magic’s announcement was tantamount to a death sentence. People had a real impression of the hardship faced by those suffering from HIV/AIDS. Fortunately, the medical landscape did change. Treatments improved, as did the quality of life for some, but not for all.

Magic started taking a cocktail of up to 15 pills per day, and he lived. The symbol of HIV/AIDS in America, Magic’s life changed the public’s perception of those suffering from HIV/AIDS. As Associated Press Sports Writer Greg Beacham put it, “with two subsequent decades of vibrant living, [Magic] forever altered attitudes about the virus and its effects.” See, “Magic Johnson Still Beating HIV 20 Years Later.”

Sadly, the current perception of those suffering from HIV/AIDS is one of a vibrant, vigorous, and successful businessman. For all too many, this perception is also dead wrong.

Our client continues to suffer from disabling fatigue, painful neuropathy caused by his AIDS medications, and ever present, embarrassing diarrhea. This is the reality of many suffering from symptoms due to HIV/AIDS. It is also a reality that is obscured by his prominence in the public’s eye, as Magic himself reminded Beacham:

“‘I often say I’m good for the virus, and bad for it,’ Johnson said. ‘Good because I’m doing well, and that I can go out and try and raise the awareness level, get people to go get tested…but on the flip side of that, people see that I’m doing well, so they’ve kind of relaxed on HIV and AIDS. People think that now if they get the virus, they’ll do well…’”

It is not a new message that Magic is trying to spread. Five years ago Magic was quoted in USA Today: “‘You can’t take that attitude that you’re going to be like Magic,’ says Johnson…. ‘The virus acts different in all of us. There’s no certainty that if you get the virus, you’re going to be OK.’” See, “Magic Johnson Combats AIDS Misperceptions.”

But public perception is powerful, even if it has little relation to reality, and insurers are not reluctant to use misperceptions to bolster their arguments. As a result, those not as fortunate as Magic will face increased prejudice and, like our client, the all too real consequence of those misperceptions.

We believe we can get the Court to understand this, and to force Fort Dearborn to pay our client the benefits he deserves.

If you have encountered misperceptions leading to Long Term Disability benefits terminations for AIDS-related or any other disability, contact us at (800) 446-7529. We can help.

Life Insurance Company of North America Refuses to Pay Life Insurance Claim

Fri, 18 Nov 2011 10:27:32 -0800

Life Insurance Company of North America (LINA) insured the life of Timothy Whinery. Mr. Whinery died in a tragic automobile accident. His wife eventually made a claim for life insurance benefits under the LINA policy. Incredibly, even though the LINA policy promised to pay benefits for a loss "caused by an accident," the policy did not define the term "accident." Worse, in this case LINA determined that Mr. Whinery's death was not caused by an accident, and so refused to pay. The facts are a bit complicated, but in essence, LINA said that because Mr. Whinery was legally intoxicated at the time of the accident, his death was "foreseeable," and foreseeable consequences cannot be deemed accidental.

What's worse, LINA actually sells life insurance policies that contain specific provisions precluding benefits when death is caused by driving while intoxicated, but the Whinery policy DID NOT contain any such exclusion. This claim should have been paid! Our view is that LINA is acting unreasonably and in bad faith in continuing to deprive the Whinery family of the life insurance benefits they paid for. You can read more details in a Lawyers.com blog item by clicking on this link: DWI Death an Accident, Insurer's Claim Rejection Not

The case is filed in the Central District of the United States District Court and is assigned to the Honorable Percy Anderson, Judge Presiding. Trial is currently set for December 20, 2011.

Attorneys Alan Kassan and Corinne Chandler are presenters at the 21st Annual Western Region Chapter of the National Association of Professional Geriatric Care Managers held at the Bellagio Hotel in Las Vegas November 3-5

Tue, 01 Nov 2011 09:48:49 -0800

PRESS RELEASE:

LOS ANGELES, October 31, 2011 -- Kantor & Kantor, LLP announced today that lawyers Alan Kassan and Corinne Chandler are presenters at the 21st Annual Western Region Chapter of the National Association of Professional Geriatric Care Managers held at the Bellagio Hotel in Las Vegas November 3-5. The session, “Obtaining Insurance Benefits for Your Client’s Care,” is scheduled for Friday, November 4, at 2:15.

“Many people purchased long-term care insurance decades ago and before many of today’s senior care options were even contemplated,” said Mr. Kassan, a Kantor & Kantor partner who sues insurance companies on behalf of individuals denied long-term care. “As a result, since most many present care options are not enumerated in polices, and insureds have to appeal or litigate to ensure benefits for the most appropriate long-term care. Part of what we do is educate professionals in the geriatric care industry about how to understand insurance policy language and to help their clients with the legal process.”

A common reason LTC carriers deny benefits is because the policyholder resides in an assisted living facility but the 20-year-old policy doesn’t cover such facilities, which were not an option until recent years. Kantor & Kantor has successfully litigated the issue, allowing policyholders to receive benefits for assisted living.

“As the Baby Boomer population ages and requires care, we expect more options to arise for which insurers will deny coverage,” said partner Corinne Chandler. “When geriatric care professionals understand that insurance companies don’t always have the last word, they can better help their clients navigate the often complex long-term care legal environment."

About Kantor & Kantor, LLP
Kantor & Kantor is one of the largest law firms in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters. For more information, log on to www.kantorlaw.net, call (800) 446-7529, or follow the firm at www.californiainsurancelawyerblog.com.